Vermont Supreme Court Upholds Advance Directive Validity

During a period of lucidity, a mentally ill individual completed an advance directive declining anti-psychotic medications.

However, when the patient was later incapacitated and in state custody, the state facility applied for court permission to administer involuntary medication. The trial court granted the application, concluding that that patient lacked capacity to complete the advance directive and therefore the advance directive did not control the involuntary medication proceeding. 

The Vermont Supreme Court reversed, holding, in accord with settled principles of bioethics and healthcare decision making, that: 

1. Patients are presumed to have capacity
2. Having a mental illness does not necessarily mean one lacks capacity
3. Making a decision that clinicians deem unwise does not mean one lacks capacity
4. There was not otherwise clear and convincing evidence of incapacity.